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General NPI Number Information
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NPI Number | 1023063906
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Entity Type | Organization
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Legal Business Name | EAST SIDE DERMATOLOGY SERVICES PC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 317 EAST 34TH STREET 11 FLOOR
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City | NEW YORK
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State | NY
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Zip | 10016-4996
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Country | US
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Telephone | 212-686-7306
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Fax | 212-686-7305
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Provider Business Mailing Address
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Address Line | PO BOX 24904
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City | NEW YORK
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State | NY
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Zip | 10087-4904
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Country | US
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Telephone | 212-686-7306
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Fax | 212-686-7305
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ROY S SEIDENBERG
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Credential | M.D
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Telephone | 212-686-7306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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